psyc236 final

sexual dysfunction

clinically significant impairment in ability to respond sexually or experience sexual pleasure

symptoms present for at least six months, occur in 75-100% of sexual encounters, cause significant distress or impairment

sexual response cycle: linear model

excitement stage: genital tissues swell, increased muscle tension and heart rate, shallow rapid breathing

plateau stage: additional swelling, retraction of clitoris and expansion of vagina

orgasm: rhythmic muscular contractions in genital region at 8-second intervals, blood pressure and heart rate peak

resolution: body gradually returns to pre-aroused state, some men experience a refractory period and others may experience multiple orgasms

sexual response cycle: Kaplan model

treats stages as independent components

desire, excitement, and orgasm

both models used to categorize sexual dysfunctions according to what stage is affected

hypoactive sexual desire disorder

persistently or recurrently deficient or absent sexual/erotic thoughts and desire for sexual activity

sexual interest/arousal disorder (women)

combines lack of interest and arousal disorder

sexual arousal disorders

persistent difficulty becoming physically aroused even when the individual desires it

erectile disorder

difficulties obtaining an erection, maintaining until completion, or marked reduction in rigidity

phosphodiesterase inhibitors are first-line treatment

female orgasmic disorder

marked delay in, infrequency of, or absence of orgasm or a marked reduction in intensity

delayed ejaculation

delay in or infrequency/absence of ejaculation during partnered sexual activity

premature ejaculation

persistent pattern of ejaculation occurring within one minute of vaginal penetration and before the individual desires it

antidepressants sometimes used off-label

Genito-pelvic pain/penetration disorder

persistent or recurring difficulties with one or more:

vaginal penetration

vulvovaginal or pelvic pain during intercourse or attempts

fear or anxiety about pain

tensing or tightening of pelvic floor during attempted penetration

sensate focus

form of desensitization used to treat sexual fears

partners learn to enjoy physical intimacy without pressure of performance

aims to eliminate spectatoring

gender dysphoria

clinically significant feelings of distress or impairment due to lack of congruence between birth-assigned sex and gender identity

gender euphoria

satisfaction/joy when ones gendered experience aligns with gender identity

minority stress hypothesis

stigma, prejudice, and discrimination create a hostile social environment that causes mental health problems for LGBTQ+ individuals

hormone therapy

assists in developing desired secondary sex characteristics

associated with positive outcomes and improved psychological health

reparative therapy

widely rejected, attempted to change a persons identity to match birth-assigned sex

paraphilia

intense and persistent sexual interests other than those involving genital stimulation or normal foreplay with adult, consenting human partners

paraphilic disorder

a paraphilia that causes clinically significant distress or impairment to the individual, or it risks harm to oneself or others when acted on

paraphilic disorder criteria

symptoms present for six months

manifest as recurrent and intense fantasies, urges, or behaviours

usually begins in adolescence and becomes stronger and more specific with age

fetishistic disorder

intense sexual arousal from nonliving objects or a specific focus on a nongenital body part

transvestic disorder

cross-dressing to produce other enhance sexual excitement

causes distress/impairment

sexual sadism and masochism disorders

sadism: pleasure from inflicting physical or psychological pain on others

masochism: pleasure from being humiliated or suffering

only a disorder if it involves non consenting parters or causes personal distress

exhibistionistic disorder

exposing genitals to an unsuspecting, nonconsenting partner

most common sexual offence in Western countries

voyeuristic disorder

secretly watching others who are naked, disrobing, or engaging in sexual disorders

frotteuristic disorder

touching/rubbing against a nonconsenting person, typically in crowded public places

pedophilic disorder

predominant sexual preference for prepubescent children, usually 13 or younger

individual must be at least 16 and at least five years older than the victim

conditioning theories of paraphilia

accidental associations between sexual arousal and specific stimuli during development

feminist theories

offending is a result of patriarchal environment that encourage dominant, aggressive roles for men and submissive roles for women

neurodevelopmental theories

prenatal or early childhood disruptions may be factors

pedophilia linked to lower IQ and higher rates of left-handedness

social developmental theories

paraphilic behaviours appeal to people with social inadequacies or low self-confidence, since they require few social skills and ignore the needs of others

paraphilia treatment

CBT

relapse prevention by identifying precursors to offending

medical interventions (chemical castration)

risk/need/responsivity model

basson’s circular model

sexual response is not always linear, may be motivated by nonsexual rewards like emotional intimacy

toates’ incentive motivation model

desire is a state triggered by sexual cues and activation of sexual response, rather than an innate personality trait or biological drive

sexual concordance

level of agreement between physiological genital response and subjective feelings of arousal

3 P’s model of sexual dysfunction

predisposing factors: early experiences, lack of education, history of trauma

precipitating factors: relationship distress, life changes, physical illness

perpetuating factors: performance anxiety, spectatoring

substance use disorder

recurrent use of a substance that leads to adverse consequences

categorized as mild, moderate, or severe based on number of problem indicators present

four categories of indicators: impaired control, risky use, social impairment, pharmacological dependence

impaired control criteria

taking substances in larger amounts or over longer periods than intended

persistent unsuccessful attempts to cut down

spending excessive time obtaining or recovering from the substance

experiencing cravings

social impairment criteria

failure to fulfill major role obligations at work/school/home

continued use despite social or interpersonal problems

giving up important activites

risky use

recurrent use in physically hazardous situations

continued use despite knowledge of persistent problems caused by substance

pharmacological dependence criteria

tolerance and withdrawal

substance induced disorders

reversible intoxication symptoms, withdrawal syndromes, and other medication-induced mental disorders

gambling disorder

considered functionally equivalent to substance addiction in how it alters mood and satisfies similar psychological needs

etiology of substance misuse

genetic facors up to 50%, involve sensitivity of reward system

reduced dopamine transmission

behavioural disinhibition and negative affectivity

acculturation stressors, social learning

alcohol

central nervous system depressant

biphasic effect

opioids

natural and synthetic

activate endorphins to produce euphoria and pain relief

high doses lead to death via respiratory depression

withdrawal symptoms are severe and lasting

cannabis

THC and CBD

chronic use associated with amotivational syndrome

biological treatment

agonist substitution: a safer drug with a similar chemical profile to prevent withdrawal

antagonistic treatment: block or counteract positive effects of a substance

psychosocial treatments

CBT, motivational interviewing, mutual support groups

cocaine

stimulant that increases dopamine availability to produce euphoria and confidence

crack is a fast-acting crystallized form

amphetamines

include meth and designer drugs like ecstasy

stimulant and hallucinogenic properties

chronic high dose can lead to toxic psychosis and permanent serotonin depletiom

nicotine

CNS stimulant

affects nucleus accumbens, reward centre of brain

higher dependency rate

barbiturates

historically known as downers

CNS depressants

benzodiazepines

anti-anxiety or sleeping meds

safer than barbiturates but still addictive

combining with alcohol creates a synergistic effect, greatly depressing respiration and heart rate

withdrawal is extreme, similar to alcohol

hallucinogens

mimic serotonin and produce sensory and perceptual distortions

subjective experiences depend on individuals environment and expectations

little addictive potential, no withdrawal

neurodevelopmental disorders

group of heterogenous conditions that onset in developmental period

characterized by specific or global deficits that produce impairments in functioning

intellectual disability

differences in intellectual and adaptive functioning

intellectual functioning deficits: reasoning, planning, abstract thinking, judgement, etc

adaptive functioning deficits: failure to meet standards for personal independence and social responsibility

developmental onset

severity level determined by adaptive functioning

acquiescence

tendency in individuals with developmental disorders to answer affirmatively or agree in interviews due to social desirability or cognitive limitations

etiology of intellectual disability

chromosomal abnormalities

metabolic disorders

prenatal factors/toxins

autism spectrum disorder

persistent deficits in social communication and interaction alongside restricted, repetitive patterns of behaviour

few nonverbal behaviours

challenges developing peer relationships, lack of reciprocal interaction

may be totally nonverbal or have communication challenges

deficit in theory of mind

stimming

autism etiology

dominant role of genetic factors

autism treatments

applied behaviour analysis

picture exchange communication systems

specific learning disorders

documented difficulties in academic skills that persist for at least six months despite intervention

high likelihood of comorbid diagnoses like ADHD and ASD and behavioural challenges

impairment in reading (dyslexia)

stems from core deficit in phonological processing

impairment in mathematics (dyscalculia)

may reflect inability to process numerical quantities, or a core deficit in working memory

impairment in written expression

impairments in visual-motor skills, or executive functioning

dignity of risk

right of individuals with disabilities to choose to take risks and accept the associated consequences

camouflaging/masking

strategy sometimes used by individuals with ASD to mask symptoms in social situations

down syndrome

most commonly caused by trisomy 21 (extra chromosome on 21st pair)

translocation: piece of 21st chromosome attaches to another

mosaicism: cell division occurs unevenly, so some cells have 45 and others 47 chromosomes

fragile X syndrome

mutation on X chromosome

copy number variations

small pieces of chromosomes that are either missing or duplicated

frequently associated with developmental disabilities

phetylketonuria (PKU)

toxic buildup of phenylalanine in the brain

managed by diet in early life

congenital hypothyroidism

deficiency in thyroxine

fetal alcohol spectrum disorder

caused by drinking in pregnancy, binge drinking has a greater effect

varies from mild learning impairments to severe disability

school failure hypothesis

academic failure leads to increased risk of school dropout and higher rates of delinquency

susceptibility theory

youth with LDs and related problems are more vulnerable to opportunities to engage in delinquent behaviour

externalizing disorders

disorders of under-controlled behaviour

ADHD, oppositional defiant disorder, and conduct disorder

internalizing disorders

disorders of over-controlled behaviour

bullied children experience more

separation anxiety disorder, generalized anxiety disorder

disruptive mood regulation disorder

chronic and severe irritability manifested by frequent temper outbursts (3 or more times per week) and persistent angry/irritable mood in between outbursts

intersection of externalizing and internalizing

ADHD

persistent pattern of inattention and/or hyperactivity-impulsivity

strong biological basis: reduced brain size, abnormal dopamine metabolism, inactivity in prefrontal cortex and basal ganglia

maternal smoking in pregnancy significantly increases risk in children with a genetic predisposition

ADHD-I

predominantly inattentive

more common in girls

carelessness, difficulty organizing and sustaining attention

ADHD-H

predominantly hyperactive/impulsive

fidgeting, inability to stay seated, interrupting

ADHD-HI

inattentive and hyperactive-impulsive

oppositional defiant disorder

angry/irritable mood, argumentative and defiant behaviour, or vindictiveness lasting at least six months

majority of children do not develop CD

irritable mood symptoms predict later mood and anxiety disorders

conduct disorder

more severe, repetitive pattern of behaviour that violates the rights of others

aggression to people/animals

destruction of property

deceitfulness/theft

serious rule violations

includes callous-unemotional specifier, predicts more severe and persistent behaviour

failure model

engaging in externalizing behaviour increases probability of experiencing social failure, which predicts internalizing problems

acting out model

youth mask mood problems by behaving aggressively

anxiety disorders in children

internalizing, emerge by age 6

fear is developmentally appropriate when it is age-specific and proportionate to perceived threat

separation anxiety disorder

intense distress when separated from attachment figure

at least three specific symptoms: recurrent distress upon separation, excessive worry about losing a parent or harm to parent, reluctance to go places or sleep away from parent, nightmares about separation or physical complaints when separation is anticipated

minimum of four weeks of symptoms

most recover within a year but 1/3rd go on to develop other anxiety/mood disorders

generalized anxiety disorder in children

broad range of worries the child finds difficult to control

primarily defined by physical symptoms

restlessness, fatigue, irritability, tension that persist for at least six months

only one physiological symptom required

development of childhood anxiety

anxious temperament in infancy/early childhood (behavioural inhibition)

prolonged activation of amygdala

learn to fear specific stimuli through direct experience or observation

chronic stressors (poverty, maternal stress), bullying

selective optimization with compensation

old age brings losses of skills and abilities, successful aging entails selecting appropriate goals, optimizing resources, and compensating for losses

socio-emotional selectivity theory

when time is perceived as unlimited, goals tend to be future-oriented and energy is focused on expanding knowledge and horizons

when time is limited, goals become short-term and emotionally focused

strength and vulnerability integration theory

aging is associated with increased ability to regulate emotions and mitigate exposure to negative experiences

older adults are more successful at strategies like increased present-moment awareness, decrease in conflict, focus on positive experiences because they’ve had more time to practice

older adults have poorer responses to stress, under chronic stress age-related advantages in emotion regulation and well-being can be reversed

vulnerabilities in old age

chronic health problems increase, social isolation and loneliness are common, care for other older adults

depressive disorders in older adults

often chronic, poorer outlook due to comorbidity of physical diseases and neurocognitive disorders

concern among people who are sick, frail, or female

less likely to report sadness and more likely to report somatic symptoms- can lead to diagnostic overshadowing

onset is more likely to be environmental, especially because of chronic physical illness (mostly stroke) and social factors

anxiety disorders in older adults

appear twice as often as depressive disorders

symptoms frequently overshadowed by depression or attributed to normal aging

sleep-wake disorders

diagnosed when sleep disturbances cause significant impairment

up to half in older adults are undiagnosed

age-related changes in sleep

total sleep time decreases

circadian rhythms shift leading to earlier waking and more frequent napping

fewer and lower amplitude EEG activity in stages 3 and 4 (deepest)

number of REM periods stays constant, but no longer increase in length

insomnia disorder

primary problem falling asleep, staying asleep, or waking up earlier than desired

symptoms must occur at least three nights a week for three months and cause significant daytime impairment

3-P model of etiology